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Orases Consulting Corporation

March 1, 2017 effective date


Current Renewal
Company Name 1 2 3 1 2 3
CareFirst BCBS CareFirst BCBS CareFirst BCBS CareFirst BCBS CareFirst BCBS CareFirst BCBS
Plan Type / Group Size HMO / 1 - 50 POS / 1 - 50 HMO / 1 - 50 HMO / 1 - 50 POS / 1 - 50 HMO / 1 - 50
Metal Level
Gold Platinum Silver Gold Platinum Silver
Exchange Level
Off-Exchange Off-Exchange Off-Exchange Off-Exchange Off-Exchange Off-Exchange

[ ] BlueChoice Plus Opt-Out Platinum [ ] HealthyBlue HMO HSA BlueFund Silver [ ] BlueChoice HMO Referral Gold [ ] BlueChoice Plus Opt-Out Platinum [ ] HealthyBlue HMO HSA BlueFund Silver Plan -
[ ] BlueChoice HMO Referral Gold Plan
Plan Name Plan Plan - $2,000 Plan Plan $2,000
In Out In Out In Out In Out In Out In Out
Deductible $0 $0 $1,500 $2,000 $0 $0 $1,500 $2,000
Family Deductible $0 $0 $3,000 $4,000 $0 $0 $3,000 $4,000
Coinsurance 100% 100% 100% 100% 100% 100% 100% 100%
Out-Of-Pocket
$6,850 ($13,700) $1,500 ($3,000) $3,000 ($6,000) $6,550 ($13,100) $7,150 ($14,300) $1,500 ($3,000) $3,000 ($6,000) $6,550 ($13,100)

Office Visit
$40 Copay After
$30 Copay $10 Copay 100% After Ded. $30 Copay $10 Copay $40 Copay After Ded. 100% After Ded.
Ded.
Specialty Doctor Office Visit $40 Copay After
$40 Copay $20 Copay $45 Copay After Ded. $40 Copay $20 Copay $40 Copay After Ded. $45 Copay After Ded.
Ded.
Inpatient Hospital Services
(hospital copay) $500 Copay Per $500 Copay Per
$200 Copay Per $300 Copay Per $500 Copay Per Day After $200 Copay Per $300 Copay Per Adm. $600 Copay Per Day After
Day After Ded., 5 Day After Ded., 5
Adm. Adm. After Ded. Ded., 5 Day Max. Adm. After Ded. Ded., 5 Day Max.
Day Max. Day Max.

Lab
Non-Hosp: $60
LabCorp: $30 LabCorp: $30 LabCorp: $10; Non-Hosp: $60 Copay
LabCorp: $10; Copay After Ded.; LabCorp: 100% After Ded.; LabCorp: 100% After Ded.;
Copay; Hosp: $60 Copay; Hosp: $80 Hosp: $10 After Ded.; Hosp: $70
Hosp: $10 Copay Hosp: $70 Copay Hosp: $15 Copay After Ded. Hosp: $75 Copay After Ded.
Copay Copay Copay Copay After Ded.
After Ded.
X-Ray
Non-Hosp: $70
Non-Hosp: $40 Non-Hosp: $20 Non-Hosp: $40 Non-Hosp: $20 Non-Hosp: $70 Copay
Copay After Ded.; Non-Hosp: 100% After Ded.; Non-Hosp: 100% After Ded.;
Copay; Hosp: $80 Copay; Hosp: $20 Copay; Hosp: $100 Copay; Hosp: After Ded.; Hosp: $70
Hosp: $70 Copay Hosp: $45 Copay After Ded. Hosp: $100 Copay After Ded.
Copay Copay Copay $20 Copay Copay After Ded.
After Ded.

Advanced Imaging
Non-Hosp: $100
Non-Hosp: $200 Non-Hosp: $50 Non-Hosp: $100 Copay After Non-Hosp: $200 Non-Hosp: $50 Non-Hosp: $100 Copay Non-Hosp: $100 Copay After
Copay After Ded.;
Copay; Hosp: $400 Copay; Hosp: $200 Ded.; Hosp: $200 Copay Copay; Hosp: $400 Copay; Hosp: After Ded.; Hosp: $250 Ded.; Hosp: $300 Copay After
Hosp: $250 Copay
Copay Copay After Ded. Copay $200 Copay Copay After Ded. Ded.
After Ded.

Urgent Care $50 Copay After Ded.


$50 Copay $50 Copay As INN $50 Copay After Ded. $50 Copay $50 Copay As INN
Emergency Room $250 Copay, Wvd. $100 Copay, Wvd. $200 Copay After Ded., $250 Copay, Wvd. $100 Copay, $200 Copay After Ded., Wvd. If
As INN As INN
If Adm. If Adm. Wvd. If Adm. If Adm. Wvd. If Adm. Adm.
RX
10/45/65/50% to 10/45/65/50% to PlanDed-0/45/65/50% to 10/45/65/50% to 10/45/65/50% PlanDed-0/45/65/50% to 150
As INN As INN
150 Max. 150 Max. 150 Max. 150 Max. to 150 Max. Max.

RX (Details)
Plan Name BlueChoice HMO Referral Gold Plan / BlueChoice Plus Opt-Out Platinum Plan HealthyBlue HMO HSA BlueFund Silver Plan - BlueChoice HMO Referral Gold BlueChoice Plus Opt-Out Platinum Plan HealthyBlue HMO HSA BlueFund Silver Plan - $2,000